Clinical Simulation: Changing The Landscape of Nursing Education

Clinical Simulation: Changing the Landscape of Nursing Education
INTRODUCTION
Health care organizations have made dramatic advances and transformations during the
last few decades, resulting in rapid growth of technology and theory. Some of the
changes facing nursing today are an expansion in technology, consumer demand for
quality care, pressure for cost containment, decreased length of stay in hospitals, an
aging population, complex disease processes and increased patient acuity. These
changes have been associated with incumbent ethical and moral dilemmas, which are
borne out, in the daily practice of nurses. More marked changes are predicted in the
coming decades, such as the development of technology prolonging an individual’s life-
span, which compounds the aging population situation and increases the burden of
escalating healthcare expenditure.
If nurses are to deal effectively with complex change, increased demands and greater
accountability, they must become skilled in higher-level thinking and reasoning abilities.
Knowles (1980) states that “facts learned in youth have become insufficient and in many
instances actually untrue; skills learned in youth have become outmoded by new
technologies”. Nurses are now required to provide skilled, multidimensional care in
multiple, often unfamiliar environments or settings. Consequently, nurses should be
prepared to function as safe, competent, intuitive and innovative clinicians in an
environment where new information and clinical situations are constantly changing
Skills in critical thinking can provide the necessary broader outlook, creative solutions
and multiple pathways needed for successful quality improvement initiatives. In the
current climate of short staffing, cost containment and high expectations for quality
nursing care, there is an urgent need for nurses to recognize and act upon
organizational and system problems. Failure to act on these problems may result in
inequitable, poor quality or even dangerous nursing care. Snyder (2000 ) stated in the
past, nursing has not been concerned with administrative aspects of health care.
However, the time is ripe for nursing to address consumer-focused care. Nurses
comprise the majority of the hospital work force and are responsible for providing most
of the care to their patients, “therefore, it is not surprising that the overall satisfaction
with a hospital is directly related to satisfaction with nursing care”. The process of
critical thinking will enhance the ability of nurses to identify clinical indicators, assess
their significance and discuss areas for improvement. Like critical thinking, continuous
quality improvement is also seen as a never-ending process, hence, a harmonious
relationship exists between the use of critical thinking strategies and effective quality
improvement initiatives. Nurses use information from nursing practice, nursing theory
and other sciences to apply knowledge to individual situations. Through applying critical
thinking abilities to both technical and interpersonal aspects of their practice they are
able to promote creative, personalized solutions to unpredictable client circumstances.
Nurses need to be prepared for life long learning and the future nursing profession is
going to recognize a graduate who can think critically and identify complex clinical
phenomena. In order to solve unique and complex problems nurses need to be
organized and utilize information innovatively. This is an empowering activity.
BODY
Nurses and other health care professionals are under increased scrutiny to provide safe,
effective care. Likewise, nursing education programs are faced with increased pressure
to produce graduates who are capable of providing safe patient care. Toward that end,
nursing education programs develop curricula, hire qualified faculty, and select learning
experiences for students in an effort to train and graduate competent, effective nurses.
The instructional strategies utilized in both didactic and clinical components of nursing
education courses are highly influential in determining critical thinking and clinical
decision-making ability as well as in developing the psychomotor skill performance of
new graduates.
Of course, it is unrealistic to think that graduates of nursing education programs have
received all the training they need when they depart the doors of academia. Orientation
programs for new graduates and continuing education for nurses are essential tools to
help practitioners improve their knowledge, skills, and expertise so that quality patient
care is provided and outcomes are optimized while errors are minimized. Ongoing
evaluation of nursing competence is necessary to promote patient safety.
Nursing education has long utilized simulation in some form to teach principles and skills
of nursing care. Models of anatomic parts, whole body mannequins, and various
computer-based learning programs have provided educators with training tools for
students seeking to become professional nurses. Current interest in simulation as a
clinical teaching tool has largely been fueled by development of the human patient
simulator.
Clinical simulations are practical learning experiences designed to give students

exposure to a comprehensive range of clinical scenarios that may be encountered in the
workplace. Simulations equip students with essential practical skills that may be called
upon during Clinical Placements in healthcare workplaces. Developed countries such as
America, United Kingdom, Japan, Australia have been utilizing and seeing the
effectiveness of clinical simulation in their programs. Clinical simulation is integrated
into each semester of the Bachelor of Nursing and the Bachelor of Midwifery, allowing
students to become familiar with clinical environments from the beginning of their
degree. Contemporary healthcare practice emphasises patient and family centred care.
Not only do students learn technical and patient assessment skills, there is also
significant emphasis on developing communication skills to enable students to deliver
competent and professional care.
During class, students work individually and in teams to respond to hypothetical patient

and consumer scenarios in real time. Manikins ranging from newborn to adult give
students the opportunity to practice skills before implementing them in real life
situations. With labs equipped with basic manikins through to advanced manikins that
can bleed, cry and even respond to pain, students work with a wide range of
scenarios. Classes can also be recorded and played back to students so that strengths
and areas for improvement can be observed in facilitated debriefing sessions.
Human patient simulation is a relatively new teaching strategy that allows learners to
develop, refine, and apply knowledge and skills in a realistic clinical situation as they
participate in interactive learning experiences designed to meet their educational needs.
Learners participate in simulated patient care scenarios within a specific clinical
environment, gaining experience, learning and refining skills and developing
competencies; all this is accomplished without fear of harm to a live patient. The use of
simulation as a teaching strategy can contribute to patient safety and optimize
outcomes of care, providing learners with opportunities to experience scenarios and
intervene in clinical situations within a safe, supervised setting without posing a risk to a
patient.
Patient safety is a multidimensional concept that is central to clinical education.

Numerous aspects and principles of patient safety can be easily incorporated into
education of nurses and nursing students using the patient simulator. This discussion
will focus on four primary areas: preventing medication errors, developing critical
thinking and clinical decision making skills, promoting effective communication, and
encouraging teamwork.
CONCLUSION
As a clinical instructor, it is important that before a nursing student obtains his/ her
diploma psychomotor domain must be honed. Varied ways of teaching and learning
deliveries have been presented, utilized and criticized, however the contemporary but
controversial method of delivery that has been an issue is the use of clinical simulation.
There are advantages that will help the students to be equipped with the knowledge
and skills so that they can be able to effectively deliver safe and quality health care to
the respective levels of clientele. Based on studies, results indicated that simulation-
based nursing educational interventions were effective with particularly large effects in
the psychomotor domain or the skills area. In addition, the effect of simulation-based
nursing education was not proportional to fidelity level. Therefore, it is important to use
an appropriate level of simulation to meet all of the educational goals and outcomes.

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Clinical Simulation: Changing the Landscape of Nursing Education

Clinical simulations are practical learning experiences designed to give students

During class, students work individually and in teams to respond to hypothetical patient

Patient safety is a multidimensional concept that is central to clinical education.

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